An update to the 2004 APA guideline on treatment of patients with schizophrenia is underway and could be available some time next year (2018). This news was shared during an APA2017 symposium entitled “New guideline recommendations for strengthening psychiatric practice”.

Although at an early stage in development (with the writing committee still awaiting the results of a comprehensive systematic literature review) the schizophrenia guidelines-writing group lead, Dr George Keepers of the Oregon Health and Science University, was keen to ask the advice of APA delegates on what should constitute key content for the revised guideline.

Dr Keepers said the updated schizophrenia guideline will follow the template set by the most recent APA practice guidelines – containing clear recommendation-statements and strength-of-evidence categories per recommendation.

What needs to be included?

As well as conducting a review of the literature and gathering expert counsel from psychiatrists and academics, Dr Keepers said the writing group were interested to know, from APA delegates, what should stay, what should go and what might be added to the themes and content of the current guideline on treatment of patients with schizophrenia.

Opening the floor to ideas, Dr Keepers first asked delegates if they thought the latest APA ‘Practice Guidelines for the Psychiatric Evaluation of Adults, Third Edition’ might be sufficient for assessing patients with schizophrenia.

Among the other questions that might help shape the new guidelines were matters such as whether the guidelines should advise and recommend on managing patients in primary care settings and give advice on supporting psychiatrists in coordinating social aspects of patient care and housing.

In terms of the stages of disease management, he asked: should the guideline update include mention of prodromal symptoms and prevention; is there a need for guidance on measurements and assessments to determine treatment responses and should such assessments take into account patient functioning; should the emphasis during stabilization continue to be on preventing relapse while minimizing adverse events?

Delegate perspectives

Delegates flagged a number of issues of importance to their practice – such as ensuring continuity of therapy between psychiatrist and community prescribers; understanding metabolic risks and their management and the role for smart-technologies in supporting patient care. They were also interested in the themes of treatment for life and the concept of ‘recovery’, and the need to push public awareness of the need to treat early to prevent ‘kindling’ and worsening of illness when disease is poorly controlled.

An updated APA guideline on treatment of schizophrenia could be available by 2018

Registry plans

Dr Keepers also reported that the APA plan to develop a registry to help better understand treatment-effectiveness in large patient populations.

Stream of APA guidelines

During the symposium, it was also reported that a number of other new or updated guidelines are in the pipeline.  In addition to the recently published guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia, there will be a soon-to-be-released guideline on alcohol use disorders. There is also an update to the eating disorders guideline in progress.

Useful sources:

APA practice guideline for the treatment of patients with schizophrenia (current and second edition published 2004)